Whenever you hear the word ‘asthma’ and ‘diving’ being linked together, you will have an elaborate debate in the world of sports and medicine. It’s pretty obvious why such a schism exists in the first place – primarily because this sudden inability to breathe properly can have severe consequences in any circumstance, let alone underwater. Nevertheless, diving is undeniably one of the most curious, adventurous and intriguing activities that man has ever endeavored, so let’s see under what conditions an asthmatic might be allowed to do the same…

Back in the day, if you told your diving instructor that you have asthma, you would have been forbidden to dive almost instantly. Today, a person with this chronic lung inflammation has to undergo certain rigorous testing in order to get a clearance for supervised diving, but that should be an encouraging fact, nevertheless. Roughly said, the purpose of medicine is to eliminate diseases, or at least to pacify its symptoms, so in order to understand the conditions of diving with asthma, we need to understand how far we’ve come to treating this particular disease first.

Patophysiology

Physiologically speaking, an asthma attack is when muscles start to tighten around your airways, or your most important diving organs, thus constricting your airflow. Sometimes the attack can be so severe it can reach an alarming point where you can barely breathe, leading to slow asphyxiation and prompting immediate intervention, but such cases are very rare. However, less intense fits can result in recurrent episodes of coughing, wheezing, panting, shortness of breath (obviously), chest tightness and production of mucus from the lower airways, also known as sputum. Quite an unpleasant thought for sure… and even though it’s easy to diagnose someone with asthma, it’s hard to pinpoint the cause, mainly because it’s a combination of complex environmental and genetic interactions.

Underwater attack triggers

Attack triggers depend on a number of factors which are all the more potent during diving. This includes exercise, breathing cold and/or dry air, some psychosomatic conditions like stress, or claustrophobia and it can even escalate to panic, anxiety, dread and drowning. One theory suggests that once your airways narrow they could also trap breathing gas in the lungs, causing expansion injuries, or even collapsing, especially during ascents where it’s necessary to exhale before reaching the surface. However plausible it may seem, it is statistically said that the risk of underwater lung injuries is not so drastically increased among asthmatic divers which comprise 4-5% of the general diving population… as long as you know what you are doing, that is! So how can we know who is a compatible asthmatic diver and who is not?

Classification

Spirometry is the best lung function test used for aiding asthma diagnosis and management. All divers are expected to pass it, especially in Australia, while some other countries, like the UK, have two guidelines which state that well-controlled asthmatics may dive provided they haven’t needed a bronchodilator within 48 hours; and if they do not have a cold-, exercise-, or emotion- induced asthma. According to Clare Hartley from Adang Sea Divers, one of the greatest issue is taking medication prior to diving since if the effect of the drug wears off under water it can cause a number of potentially life threatening issues. So, naturally and unfortunately, anyone with severe asthma (daily chronic symptoms) should not consider diving at all. Those, however, who have a mild condition, which is intermittent and controllable, may yet get their clearance as long as they can manage this disease with their medication to the point where exercise and other triggers won’t cause any incidents. If you want the full classification review – click here!

Clearance

The best and most certain way to see if you qualify is by taking the airway challenge – a test involving meticulous data-collecting and data-analysis where your exercise on a treadmill at increasing intensity, while a doctor measures your airflow stability, as well as vigor and endurance. Last thing you know you might be doing the whole thing inside a scuba tank, which isn’t an uncommon procedure, considering all the risks! Also, talk to your doctor about useful medications which will help you during your diving. For instance, aminophylline is an older oral medication that may dilate your smooth airway muscles, but it does that to your arteries in the lungs, too, increasing the risk of DCS (decompression sickness). Go for the newer generation of bronchodilators like Albuterol, which relaxes the airways for four to six hours, keeping your lung arteries as they were.

Medicine and sports have come a long way so that underwater realms can be a place for asthmatics, too. Still, the most prudent thing to do is to practice caution. Seek out additional information, analyze your body, your capacities and your limits before you decide to dive. Remember that safety should always come first, no matter the medical condition, but no one should have to lose their sense of adventure because of it…

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